DG2 Form

Application Type
Application type

New connection - In addition to this form you also need to complete the New Connections application formUpgrade to an Existing connection - If this application is for an existing connection please enter your unique ICP number below:
ICP Number
Site Details

This refers to the site where the distributed generation is to be installed
Site address

Street Address

Street Address Line 2

CitySuburb

Postal / Zip Code
Other identifying remarks
Please state what this site will be used for

DwellingCommercialIndustrialPumpOther
Distributed Generator Details

This is the party who owns and is responsible for the distributed generation installation
Full legal name
Contact name

First NameLast Name
Email
example@example.com
Contact phone

Area CodePhone Number
Physical address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Postal address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Party

Individual / CoupleCompanyOther legal entity - specify
Distributed Generation System Installer
Full legal name
Company
Contact Name

First NameLast Name
Email
example@example.com
Contact phone

Area CodePhone Number
Physical address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Postal address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Distributed Generation Type / Fuel Type
Generation type / fuel type

SolarGas turbineSteam turbineFuel cellWind turbineMicro hydroLiquid fuelOther
Inverter specification
Manufacturer / supplier
Model number
Rated capacity (kW)
Export kW load value*
If inverter used, is it AS4777 compliant?

YesNo
Other Details
Specify any other information or special terms that are or may be relevant to this application
Supporting documentation

Cancelof
As the legal owner and distributed generator, we hereby request to connect a distributed generator device over 10kW to Counties Energy Limited’s electricity network.

We confirm that the information submitted within this application is accurate and correct.

We hereby agree to comply with all requirements of a distributed generator as required under Part 6 of the Electricity Industry Participation Code 2010.

We confirm that we will inform Counties Energy of any future changes to the distributed generation installation. We confirm that we will comply with all safety requirements as required by a distributed generator.

We confirm that we are aware of our responsibility to arrange for the installation to be tested and inspected, prior to connection.

We hereby accept all charges in relation to processing this distributed generation application form.

This document must be signed by the party that seeks to become the distributed generator. Third parties are not permitted to sign this document on behalf.
Distributed generator name
Date

DayMonthYear
Date
Should be Empty:

Application Type

Site Details

Distributed Generator Details

Distributed Generation System Installer

Distributed Generation Type / Fuel Type

Inverter specification

Other Details